TCI Global Toolkit: TCI Essentials

Adaptation

Adapting Proven Program Approaches and Tools

What Is It?

Adaptation is the process of tailoring evidence-based approaches, learning content, communication materials, implementation tools or other materials to make them more suitable for a particular population, context and/or technical area without compromising or deleting core components of what made the approach or tool effective in the first place.

What Are the Benefits?

Adapting a proven approach or tool ensures that your approach and content are evidence-based and high quality.
Adaptation can make the proven approach or tool more acceptable, usable, and effective among a new population or context.
Adaptation improves your efficiency by saving time and/or money without compromising accuracy and quality.

How to Implement?

Why Adapt a Proven Program Approach or Tool?

The needs or characteristics of the priority population in a new geography are different from those of the population where the approach or tool was previously implemented. For example, there may be differences in socioeconomic characteristics, cultural norms, language, and/or other contextual factors.
The program goal in the context of the new application is different from that of the original application that was tested and proven to be effective.
There may be other program interventions already underway or planned that overlap with the new application of the approach or tool.
There are new stakeholders or partners involved that impact the application of the approach or tool.
There are variations in the financial or human resources and expertise available for the new application of the approach or tool.

Review what you know about the approach as well as your population and context

Review the landscape analysis, gap analysis and prioritization tools that you completed as part of TCI program design.

What are the main objectives of your program? Can they be accomplished through your chosen approach(es)?
What are the needs and characteristics of your priority population(s)?

If possible, gather the program design team and key implementers to complete this adaptation tool together. Involving these stakeholders in the selection and adaptation of the approach will help to build their support for the approach as well as ensure that the selected approach fills a real need and doesn’t duplicate other programming efforts.

Assess facilitators/barriers to implementing the approach

Ask yourself, is your chosen approach consistent with local systems and operations? There may be a number of local and/or national elements that would either support or block the success of your chosen approach. Policies or standards already in place may dictate whether or how you implement any given approach. With this in mind, consider two types of contextual elements that may support or hinder the success of the approach in your unique context:

The political environment (specifically policies, standards, and protocols for services at institutional, local, and national levels); and
The socio-cultural environment (including key beliefs, practices, groups and institutions that favor one group of people over another, and in doing so, influences health exposures, vulnerabilities, access to services, outcomes, etc.)

Identify the unique demographic for which the approach is intended

Has your chosen approach been implemented to serve a population similar to the population of your geography? If not, think about some demographic elements that should be taken into account when adapting the approach to your unique context. This is possible by identifying the demographic differences between the population served by the initial approach and that of your geography. Then, for each identified difference, note whether or not it is necessary to adjust the approach in order to take these demographic differences into account. Example demographic characteristic include:

Age group
Marital status
Urban/rural composition
Socio-economic status
Religious composition

Consider adaptations to the approach and make final decisions about how to adapt

After assessing the factors within the local context that may facilitate or block the implementation of your chosen approach and considering the unique demographics of your target geography and intended audience, then consider any necessary adaptations – modifications as well as adjustments – to make the approach more suitable. These adaptations should take into account the context (local, regional, national) as well as the expected results.

Tip:

Visit the TCI University Global & AYSRH Toolkits to locate the web page where you can find specific information on how to implement your chosen approach as well as tips, challenges, and considerations for adaptation. With this information, you can ensure an understanding of the approaches and of the aspects necessary for their success in different contexts.

Once you have identified each necessary adaptation to be made to the approach, then assess the “colored light” that corresponds to each. Use the TCI Program Approach Adaptation Tool for this process.

	Red: Stop! These adaptations remove or alter key aspects of the program approach that may weaken its effectiveness.
	Yellow: *Caution!* These adaptations should be made with caution so that the core components of the approach are adhered to and the adaptation does not cause any unintended consequences.
	Green: Go for it! These adaptations are appropriate and are encouraged so that program approach better fits the age, culture, and context of the population.

Adaptations that receive a green or yellow light are ready to be adapted!

For each of the green or yellow adaptations, identify all the steps necessary for putting the adaptation into practice, including the persons responsible for making the adaptation and the implementation timeframes.

Identify potential partners and other similar approaches

In addition to the program design team, there are likely other stakeholders in the area implementing similar projects. These stakeholders may already be recognized as partners or you may identify new stakeholders that require partnership development. It is important to collaborate with influential stakeholders in order to compliment and strengthen the impact of your adapted approach and to avoid duplication of efforts.

Ask yourself, are there partners or stakeholders implementing similar approaches in my geography?

If yes, identify them and the approach(es) they are implementing. Then, ask how you might take these partners, their approaches and projects into account with regard to your adapted approach? Should you make more adaptations to your approach or consider collaborative or joint efforts?

For each stakeholder you have identified, think about the steps required to collaborate with them and/or adjust your approach towards strengthening and expanding these complementary projects, and avoiding activity duplication.

Adapt tools needed to implement the approach

What tools are already available for implementing this approach? If you adapt a program approach, you may still be able to use some or all of the tools and materials produced during implementation of the original program. More likely, however, you will need to adapt some or all of the materials to accommodate your adapted approach to your new context. Here are some questions you may want to ask about the tools:

Are the language, images, and examples appropriate for the priority population, considering their education level, cultural norms and values, and literacy? Does the language reflect the terms used locally to describe the situations and behaviors that you are aiming to change?
Is the information up-to-date thematically or clinically?
Is the tool in line with national or local guidelines or does it need to be specially formatted?
Do you need to develop new tools?

For each tool, identify any necessary adaptation and repeat the red, yellow, green light exercise to verify each adaptation.

	Red: Stop! These adaptations remove or alter key aspects of the program approach that may weaken its effectiveness.
	Yellow: *Caution!* These adaptations should be made with caution so that the core components of the approach are adhered to and the adaptation does not cause any unintended consequences.
	Green: Go for it! These adaptations are appropriate and are encouraged so that program approach better fits the age, culture, and context of the population.

Pre-test the adapted tools

Once you have adapted the tools, you should pre-test or pilot them to ensure the intended audience understands and reacts to them the way you intended. For a complete guide on pre-testing materials, see the HealthCOMpass How-To Guide, “How to Conduct a Pretest.”

Continue to monitor and learn from implementation and refine as needed

See the TCI Data for Decision Making approach for more detailed information and tools on how to integrate this step into your project.

What Are Program Examples of Adaptation?

In Senegal, the Urban Reproductive Health Initiative conducted a situational analysis to determine the root cause of a logistics problem. They then reviewed and analyzed commercial-sector solutions and applications of those solutions in public health systems. The “Delivery Team Topping Up” system in Zimbabwe, a successful example of a widely practiced vendor-managed inventory model, provided a foundation on which to build a model adapted to Senegal’s environment and needs. This led to development of the “Informed Push Distribution Model” (IPM), which uses trained logistics operators to deliver supplies to points of sale on a regular schedule, restocking where necessary and recording quantities of products sold. The logistics operators collect data that are then used to ensure that each site and warehouse is sufficiently stocked, allowing manufacturers to keep pace with demand. This takes the burden of tracking and ordering inventory off of pharmacies and clinics.

In Kenya, the Tupange project adapted the Informed Push Model by introducing an SMS/web-based commodity tracking system to collect consumption data from facilities. The data were then transmitted to a central server using a mobile phone.

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Helpful Tips

Look at the program approach with a critical eye, considering whether it would make sense to implement it in your context, whether it would appeal to members of your audience, and whether it is likely to have the desired effect on their knowledge, skills, relationships, or behavior.
In general, the fewer changes made to a proven program approach, the more likely it is to have the desired effect as it did when it was originally implemented and evaluated.
Assess the need for cultural adaptation. Consider the language, visuals, examples, and scenarios used in the program and the activities that participants are asked to engage in. Will the average client or provider understand the words used in the materials? Do other terms exist in your country? For example, the “menstrual cycle” can be referred to as “menstrual bleeding,” “periods” or “spotting.”
Pre-testing materials doesn’t need to be formal or conducted by researchers. When it comes to pre-testing, do what you can do. Any feedback is better than none.
For more detailed guidance on adapting materials, check out the HealthCOMpass How-To Guide, “How to Adapt SBCC Materials.”
Another helpful resource for adapting materials is the guide, “Making Content Meaningful: A Guide to Adapting Existing Global Health Content for Different Audiences”.

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Challenges

Making sure a program approach is a good fit for all stakeholder groups takes time, but it also increases the likelihood that the community will support the selected approach and participate in it.
Aspects of fit may change over time and are influenced by a number of factors, including the economy, funding, changes in the demographics of the community, or shifts in organizational operations. By staying up-to-date with potentially relevant internal and external influences, you will be in a better situation to continuously improve fit, as well as respond to factors that could affect the longer-term sustainability of the program.

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